The URL can be used to link to this page

Home My WebLink About6724-z FO~ NO. e, TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN C:LERK'S OFFICE $OUTHOLD, N,. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 672~ Z Permission is hereby grante~ to: ' . ....... ~'.~.a~...u.. .......... ~../..,. ........ /.zz..~...~ ~o..~.~ ....... A.~.:~.:..~.~..~...T...~...Z.~.~ ........ 2.~.:..~..~.,..:~...~ ........................................ at premises located at ......~..,~~ .............. /J/J .................................................................. ~ l[~J .~..~ ..A~.. ......................... pursuant to application dated ................ ~ ................. f/..... 19.~...~. ..... , and approved by the Building Inspector. Fe~ ~...~.~.~i~.i ..... Building Inspecttr FORNI NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined ..........;],.,>~.v~,.,..;....././......, 19..:i.~.. Approved .........'(u':'/'"'m ......... / ' ........ , 19.~.~... Permit No.~,T/...;~.ltl..J~,.i ........... Disapproved a/c ............................................................................................ ..................... ................................. (Building Inspector) A~PLICATION FOR BUIL~IN~ P~RMIT .......... ....... ......... I~STRUCTIO~S Application No. ~...)..r;)...:/(. ................ a. This application must be completely filled in by typewriter on in ihk and submitted in triplicate to the Building Inspector, with 3 sets of plans, accurate plot plan to scale. Fee according '(o schedule. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets or areas, and giving a detailed description of layout ofproperty must be drawn 6n the diagram which is port of this application. c. The work covered by this application may not be commenced befor~ issuance of Building Permit. d. Upon approval of this application, the Building Inspector will issue ~ Building Permit to the applicant. Such permit shall be kept on the premises available for inspection throughout the world. e. No building shall be occupied or used in whole or in part for any purpose whatever until a Certificate of Occupancy shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the '.issuance of a Building Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or Regulations, for the construction of buildings, additions or alterations, or (or removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances, buildihg code, housing code, and regulations, and to admit authorized inspectors on premises and in buildings for necessary.inSpection~ ..... .../,, :~;./~;,~-.~--;~....:..::..: ....... / (Signx~Eu!e of applicant, c name, if a corporation) ..... ' ......... :....,, .............................. ?,'.~;~..., ~/.. Z ~( ............. (Address o! ~pplicant) (./ State whether applicant is owner, lessee, agent, architect, engineer, gener?l contractor, electrician, plumber or builder. If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No ..................................................... Plumber's License No. '" Electrician's License No. Other Trade's License No ............................................... Location of land on wh'ch proposed work will' be done Map No .~.. ..... Lot No *~ Street and Number .... .~.....~d..A.)..~ ........ ~ ....... .g..~¢~ .............. ];.~...c..,.~.~ ...................................................... -- : Municipality State existing use and occupancy of premises and in!ended use and occupancy of proposed construction: o. Exisiting use and occupancy ..... IL...t,(,../:..~,'...t........~,:..~):*..~....L.q~....i.....~L,..LS.k!.!~' ..................................................... b. Intended use and occupancy ..... ./:'.~...~.;..%C~ ...... ~.L.4~.('~ ................. ~?.(~.!:.,,.,..~,,,.l.; ........... :t....:~ ..........~.~ 3. Nature of work (check which applicable): New Building .................. Addition .................. Alteration ................ Repair .................. __l~e~r-°val .;~....~__~ / .... Qt~er Work ................................................ ~ .) ........ Demolition ........... "~'* -"-" (Description) 4. Estimated Cost .............................................. ?~. ......... Fee ......................................................................................... (to be paid on filing this application) 5. If dwelling, number of dwelling units ............................ Number of dwelling units on each floor .......................... If garage, number of cars .................................................................................................................. ./),f'~ ........ ~ ..... 6. If business, commercial or mixed occupancy, specify nature and extent~f each type of use ........................... 7. Dimensions of existing structures, if any: Front ............................ Rear ................................ Depth .................... Height ........................ Number of Stories ................................................................................................................ Dimensions of same structure with alterations or additions: Front .................................... Rear ........................... Depth ................................ Height ....................... ..~/..f';lumber of Stories ...... ..~.t..2 ................../. ~. 8. Dimensions of entire new construction: Front"Z~../,....-Z-,.-~ .................. Rear ............................ Depth ....................... Height .................... Number' of Stories ....................................................................................... /..... ........ / ............. 9. Size of lot: Front ........................................................ Rear ................................ ~/....~h~-Depth ............................... 10. Date of Purchase ........................................................ Nar~ of I~¢mer,7Owner ........................................................ 1 I. Zone or use district in which premises are situated ..................................................... /~....). ...................................... 12. Does proposed constructior/'VloJ~te any zoning law, ordinance or regulation: ........................................................ 13. Will lot be regraded ..........~.~.~....lJ~J~i~l~s~s~f~Pl~h~oved from premises: ( ) Yes ( ) No 14. Name of Owner of premises .................................................... Address ................................ Phone No ....................... Name of Architect .............................................................. Address ................................ Phone No ....................... Name of Contractor ............................................................ Address ................................ Phone No ....................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate ail set-back dimensions from property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NE~, COUNTY OF ....... t.1 .................... ................................................................................................. being duly sworn, deposes and says that he is the applicam (Nome of indivi~c~Jol signing cont~ract) above named. (.,,~"C~O-~ ~L,~ He is the ............................................................................................................................................................................... (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this application; that all statements contained in this application are true to the best of his knowledge and belief; and that the work will be perfo~d in t~ manner set forth~ me applic~io~ ~iled the~th~ Sworn to bel~e me this ~.- ~1 "~ '~ // '"/ / ' , ~~/~ ,/ Notary ........................ Public,. de, of ..... ...... ........... .............. Co.nty.'-¢:I ......... /¢ .................. ........ ,'> ........................................ /'--Y (Signature of'~pplicant) T[~I LEE E~K ITEM NO.